Advocacy Paper for FEES

Patients who are elderly require the most excellent possible care, so nurses and physicians must evaluate their patients’ swallowing ability. In my study, I found that one author had an elderly family member hospitalized for End-Stage Renal Failure. She noticed that she had difficulties swallowing. Patient safety is improved by precision in diagnostic investigations of swallowing capacities and a correct treatment technique. This researcher selected this subject as a particular interest since she considers it fascinating that the reserve currency of swallowing testing, the barium swallow, is only offered in institutions and not in care homes. Starvation, dehydration, pneumonia, and even mortality can occur due to faulty diagnostic tests (Kim et al., 2016). This letter will provide advocacy for the students that are going through hardship on swallowing and those that will come, that they may be considered, and the institution provides fees, equipment, and training.

As it is well known, the strength of swallowing is significant. Impairment in tongue function and power can lead to hardship in manipulating food into boluses; thus, assertive the bolus back to the mouth and taking them from the mouth, passing over the gullet directly to the top digestive system, becomes a challenge (Steele et al., 2016). Researches on dysphagia has proven that tongue firming is for people suffering from oropharyngeal dysphagia. It could be critical for them to receive equipment and training to improve their safety while swallowing and dietary intake. Uncontrolled research has shown that tongue strengthening exercises, which our school requires as part of a dysphagia therapy program, could be efficient for individuals with swallowing ailments. On the other hand, the controlled research has not proven whether tongue strengthening added to the old-style dysphagia therapy can help enhance swallowing care. So, up-to-date, there is no proof of whether tongue strengthening helps the patients improve their swallowing safety.

In the past few years, the devices have been designed to assist patients in improving their tongue strength as part of treatment and control programs. There is, therefore, confusion about whether this device will work for every individual that requires help with tongue strengthening. Therefore, as much as we need the equipment, training is crucial. Some of the students may not even be aware of the application of these devices. Some of the equipment that research has proved to be efficient for increasing tongue pressure includes the following:

Lowa Oral Performance Instrument (IOPI), which has the functions of measuring tongue and lips strengths. This device is easy to use since the individual places a bulb filled with air in the mouth and presses it on the top of the mouth with the tongue for a given period as prescribed and recurrences. This equipment measures the tongue energy in kilopascals. The biofeedback is revealed for a light array on the device held on hand (Potter, Bajwa, Wilson & VanDam, 2020). With the help of a clinician, the device can be set and modified to target the required pressures.

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The other equipment is Tongueometer, a biofeedback gadget that monitors and trains tongue endurance and strength in your hand. The equipment links to a handler’s tablet or smartphone and works with a permitted app that may be downloaded (Potter, Bajwa, Wilson & VanDam, 2020). The application has four evaluation and workout units that enable handlers and clinicians to quickly alter settings, view biofeedback, save workout outcomes, and generate a Data Report from inside the app. Although the bulb is intended for single usage, the hand-held equipment can be applied by several patients. This equipment can measure the tongue pressure in kilopascals (kPa).

The third piece of equipment we would require is SwallowSTRONG. The system includes a handmade tablet, mouthpiece, and easy-to-use applications. Before starting treatment, a clinician will assist in molding the agent towards the top of the patient’s mouth. The mouthpiece has four different but connected sensors that address the back, front, and tongue edges. The patient presses the tongue on the sensors on the tablet and puts the mouthpiece towards the upper part of the mouth. The software program determines therapeutic targets immediately and displays interactive online biofeedback. Hectopascals are used to evaluate tongue pressure with this equipment (hPa). Data is gathered and shared with a therapist to track development over time (Kim et al., 2016). The mouthpiece is designed for one patient, but the setup (software and tablet) can be employed with several users.

Apart from suggesting the equipment, some factors to consider before the equipment has been purchased. The devices should be easily carried or rolled to the patients on their beds. Since this is an institution, we consider that the equipment is in a package of both portable and static for those who can reach the device itself and those in bed. Mobile devices should be lighter and smaller because of transportation logistics (Park, Oh, Yoon & Park, 2019). Also, the devices can be selected based on the quality and size of the images produced by the attachable cameras. Images are shown directly to a personal laptop or a larger display screen, replacing the viewing optics. While digital endoscopes are more expensive than fiberoptic endoscopes, they are strongly suggested over the outdated equipment. When evaluating, assessing, and evaluating FEES research, it pays off.

It is our great hope that our request will be considered for the sake of the well-being of our students as much as the FEES equipment and training are concerned. With this consideration, the health facility in the institution and our colleagues will be helped in increasing the tongue strength.


Kim, H., Choi, J., Yoo, S., Chang, M., Lee, S., & Park, J. (2016). Tongue-to-palate resistance training improves tongue strength and oropharyngeal swallowing function in subacute stroke survivors with dysphagia. Journal Of Oral Rehabilitation, 44(1), 59-64. doi: 10.1111/joor.12461

Park, H., Oh, D., Yoon, T., & Park, J. (2019). A double-blind, randomized controlled trial, the effect of effortful swallowing training on tongue strength and oropharyngeal swallowing function in stroke patients with dysphagia. International Journal Of Language &Amp; Communication Disorders, 54(3), 479-484. doi: 10.1111/1460-6984.12453

Potter, N., Bajwa, A., Wilson, E., & VanDam, M. (2020). Developmental Changes in Tongue Strength, Swallow Pressures, and Tongue Endurance. Dysphagia, 36(5), 854-863. doi: 10.1007/s00455-020-10200-4

Steele, C., Bayley, M., Peladeau-Pigeon, M., Nagy, A., Namasivayam, A., Stokely, S., & Wolkin, T. (2016). A Randomized Trial Comparing Two Tongue-Pressure Resistance Training Protocols for Post-Stroke Dysphagia. Dysphagia, 31(3), 452-461. doi: 10.1007/s00455-016-9699-5

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